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3 "Wounds, penetrating"
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Original Articles
Indications for Laparotomy in Patients with Abdominal Penetrating Injuries Presenting with Ambiguous Computed Tomography Findings
Eun Ji Choi, Sanghee Choi, Byung Hee Kang
J Trauma Inj. 2021;34(2):112-118.   Published online June 8, 2021
DOI: https://doi.org/10.20408/jti.2020.0058
  • 2,742 View
  • 88 Download
AbstractAbstract PDF
Purpose

Negative laparotomy in patients with abdominal penetrating injuries (APIs) is associated with deleterious outcomes and unnecessary expense; however, the indications for laparotomy in hemodynamically stable patients with ambiguous computed tomography (CT) findings remain unclear. This study aimed to identify the factors associated with negative laparotomy. findings

Methods

Data of patients who underwent laparotomy for APIs between 2011 and 2019 were retrospectively reviewed. Patients who presented with definite indications for laparotomy were excluded. The patients were dichotomized into negative and positive laparotomy groups, and the baseline characteristics, laboratory test results, and CT findings were compared between the groups.

Results

Of 55 patients with ambiguous CT findings, 38 and 17 patients were assigned to the negative and positive laparotomy groups, respectively. There was no significant difference between the groups with respect to the baseline characteristics or the nature of the ambiguous CT findings. However, the laboratory test results showed that there was a difference in the percentage of neutrophils between the groups (negative: 55.6% [range 47.4–66.1%] vs. positive: 79.8% [range 77.6–88.2%], p<0.001), although the total white blood cell count was not significantly different. The mean duration of hospital stay for the negative laparotomy group was 13.1 days, and seven patients (18.4%) experienced complications.

Conclusions

Diagnostic factors definitively indicative of laparotomy were not identified, although the percentage of neutrophils might be helpful. However, routine laparotomy in patients with peritoneal injuries could result in instances of negative laparotomy.

Summary
Diagnostic and Therapeutic Laparoscopy for Abdominal Trauma: A Single Surgeon’s Experience at a Level I Trauma Center
Hancheol Jo, Dong Hun Kim
J Trauma Inj. 2021;34(4):248-256.   Published online March 15, 2021
DOI: https://doi.org/10.20408/jti.2020.0081
  • 3,240 View
  • 104 Download
AbstractAbstract PDF
Purpose

Laparoscopy has various advantages over laparotomy in terms of postoperative recovery. The number of surgeons using laparoscopy as a diagnostic and therapeutic tool in abdominal trauma patients is increasing, whereas open conversion is becoming less common. This report summarizes a single surgeon’s experience of laparoscopy at a level I trauma center and evaluates the feasibility of laparoscopy as a diagnostic and therapeutic tool for abdominal trauma patients.

Methods

In total, 30 abdominal trauma patients underwent laparoscopy by a single surgeon from October 2014 to May 2020. The purpose of laparoscopy was categorized as diagnostic or therapeutic. Patients were classified into three groups by type of surgery: total laparoscopic surgery (TLS), laparoscopy-assisted surgery (LAS), or open conversion (OC). Univariate analysis was performed to determine the advantages and disadvantages.

Results

The mechanism of injury was blunt in 19 (63.3%) and penetrating in 11 patients (36.7%). Eleven (36.7%) and 19 patients (63.3%) underwent diagnostic and therapeutic laparoscopy, respectively. The hospital stay was shorter for patients who underwent diagnostic laparoscopy than for those who underwent therapeutic laparoscopy (5.0 days vs. 13.0 days), but no other surgical outcomes differed between the groups. TLS, LAS, and OC were performed in 12 (52.2%), eight (34.8%), and three patients (13.0%), respectively. There was no significant difference in morbidity and mortality among the three groups.

Conclusions

Laparoscopic surgery for selected cases of abdominal trauma may be feasible and safe as a diagnostic and therapeutic tool in hemodynamically stable patients due to the low OC rate and the absence of fatal morbidity and mortality.

Summary
Comparison of Penetrating and Blunt Traumatic Diaphragmatic Injuries
Sang Su Lee, Sung Youl Hyun, Hyuk Jun Yang, Yong Su Lim, Jin Seong Cho, Jae Hyug Woo
J Trauma Inj. 2019;32(4):210-219.   Published online December 30, 2019
DOI: https://doi.org/10.20408/jti.2019.034
  • 4,053 View
  • 94 Download
  • 2 Citations
AbstractAbstract PDF
Purpose

Traumatic diaphragmatic injury (TDI) is no longer considered to be a rare condition in Korea. This study investigated differences in the prevalence of accompanying injuries and the prognosis in patients with traumatic diaphragmatic damage according to the mechanism of injury.

Methods

We retrospectively reviewed the medical records of patients with TDI who were seen at a regional emergency medical center from January 2000 to December 2018. Among severe trauma patients with traumatic diaphragmatic damage, adults older than 18 years of age with a known mechanism of injury were included in this study. Surgery performed within 6 hours after the injury was sustained was defined as emergency surgery. We assessed the survival rate and likelihood of respiratory compromise according to the mechanism of injury.

Results

In total, 103 patients were analyzed. The patients were categorized according to whether they had experienced a penetrating injury or a blunt injury. Thirty-five patients had sustained a penetrating injury, and traffic accidents were the most common cause of blunt injuries. The location of the injury did not show a statistically significant difference between these groups. Severity of TDI was more common in the blunt injury group than in the penetrating injury group, and was also more likely in patients with respiratory compromise. However, sex, the extent of damage, and the initial Glasgow coma scale score had no significant relationship with severity.

Conclusions

Based on the findings of this study, TDI should be recognized and managed proactively in patients with blunt injury and/or respiratory compromise. Early recognition and implementation of an appropriate management strategy would improve patients’ prognosis. Multi-center, prospective studies are needed in the future.

Summary

Citations

Citations to this article as recorded by  
  • An audit of traumatic haemothoraces in a regional hospital in KwaZulu-Natal, South Africa
    CM Kithuka, VC Ntola, W Sibanda
    South African Journal of Surgery.2023; 61(3): 12.     CrossRef
  • Factors Associated with Successful Video-Assisted Thoracoscopic Surgery and Thoracotomy in the Management of Traumatic Hemothorax
    Heather M. Grant, Alexander Knee, Michael V. Tirabassi
    Journal of Surgical Research.2022; 269: 83.     CrossRef

J Trauma Inj : Journal of Trauma and Injury